MGMA · Identify and Reduce Revenue Cycle Pain Points in the Patient Financial Experience
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Revenue Cycle Management (RCM) pain points can be felt by healthcare professionals and patients, too. RCM experts Kem Tolliver, CMPE, CPC, CMOM, president and CEO of Medical Revenue Cycle Specialists and Shawntea “Taya” Gordon, MBA, CMPE, CMOM, chief revenue cycle office with H4 Technology, LLC, joined the MGMA Insights podcast recently to share their thoughts on those pain points from a patient perspective.
Editor’s note: The following Q&A has been edited for length and clarity.
Q: One of the sessions that you’re going to be involved in is on (RCM) pain points.
Tolliver: This concept was developed after Taya and my own personal experiences as patients in the healthcare system. We have seen a lot of broken and disjointed processes as patients ourselves. We have that healthcare financial literacy that most patients do not have and what we wanted to do was challenge our audience to think from the patient’s perspective and (show) how we can close some of these gaps that might keep patients out of care because they don’t understand bills, or they’re getting incorrect bills.
Gordon: I went to the ophthalmologist because my daughter is like a ninja … she went to grab something and cut me right across the eye. An 18-month-old ninja is what I’ve got at home. So, I called (the medical practice) on the phone, 'Can I come in today?' … And they said, 'Absolutely, and if you give me your insurance info, I’ll run it right now. You have a deductible.' So, I get to their check-in and said, 'I need to pay this deductible amount,' and she goes, 'No, no, you’ll do that at checkout.' I get seen by the doctor ... and then she’s like, 'Alright, you’re free to go.' I said, 'Where’s the checkout desk?' And she says, 'I don’t think we do that.'
About a full month later, I got an invoice for the amount I could have paid that day and was happy to pay that day. It’s just stuff like that. Come on, why are we doing this to ourselves? I tried with three different people to give (them) my money. Instead, I had to go through this entire process of billing and the practice sending it to me in an invoice, which costs money. ... One of the most frustrating things is that someone in that organization, the (first) person I was on the phone with, knew precisely what they needed to be doing. Unfortunately, it was hindered by everybody else who didn’t. Do we have a lack of education? A lack of training? Do we have a process breakdown?
Q: Did you find out what the cause of the hindrance was?
Gordon: In this particular instance … she was actually coached by her management team. ‘No, that’s the way you did it at the other place. We don’t do that here. Our patients can’t afford to do that and we’re not going to do that here,’ sort of thing, which we hear a lot. If your patients truly can’t afford something that happens, that’s why we have financial hardship programs and sliding fee payments. But to make that generalized statement was huge. So, in this situation, it was a lack of process even existing, it wasn’t a process breakdown. She was actually coached to not behave that way going forward.
Tolliver: Imagine now what it looks like from a disjointed process when you have some folks who are working from home and others who are in the office, and they’re not communicating. The person who is on the phone telling the patients what they should be paying - it’s not the person who’s in the office actually interacting with that patient in person. There’s a lack of communication or disjointed processes there as well. It’s really about making sure that we see all of our processes as uniform and standard for the entire organization, and that we’re making the best decisions on behalf of the organization and the patient, because at the end of the day, the patient is going to get the bill … We don’t want to spend extra money sending out a patient statement, which then increases our overall healthcare costs and expenses. … Our expenses don’t need to be high if we’re using Lean processes and educating our staff correctly.
Q: Do you have anything else you want to share with us about the money that’s falling through the cracks in a practice?
Tolliver: It's, unfortunately, not uncommon. ... I was meeting with a client on Friday. I had to break the news to her that last year, there was $190,000 worth of unreimbursed reimbursable services. We're still technically in a public health emergency. The last thing that we need is patients avoiding care because of cost issues, right? So, everyone wants a Taya as their patient who is begging you for their money, but guess what, not all patients are going to be Taya. They are not going to do the due diligence that Taya did to make sure that you get paid. So what we want to do is, in addition to addressing those pain points, and looking at the RCM from the patient's perspective, what we also want to do with our audience in Boston, is to think about that strategic plan, and identify those ways that you can fill the gaps in your revenue cycle, put the right processes in place, use the right technology, and make sure that your staff are as educated as possible with the roles that they play in your organization's RCM.
Q: Tell us about your second session in Boston. What can attendees expect to learn?
Tolliver: We are going to do an encore presentation about developing your strategic RCM work plan session, which we first did at the financial conference. We offer our assessment tools, screening tools and case studies. We’ve really incorporated corporate strategic planning methodology into revenue cycle, and that gives our audience the tools and the resources they need to identify the gaps.
Gordon: One of the really cool things about this is that it’s so quickly actionable. We grew up working with other practice managers in small practice management and symposium groups where everybody helps everybody else out. We’re able to pay something forward that is meaningful and gives us that opportunity to continue to network like we used to in the old days, when we were all on site together.
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The MGMA Insights podcasts are produced by Daniel Williams, Rob Ketcham and Decklan McGee.
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